Neue Empfehlungen für die Umgebungsuntersuchungen bei Tuberkulose

Abstract

Nach der Einführung der neuen Interferon-γ-Release Assays (IGRAs) Abstract !In 2007, the German Central Committee against Tuberculosis (DZK) published recommendations for contact tracing that introduced the new interferon gamma release assays (IGRAs). Meanwhile, substantial progress has been made in documenting the utility of IGRAs. Because IGRAs are usually superior to the tuberculin skin test (TST) in detecting latent TB infection (LTBI) with respect to sensitivity and specificity in adult contact populations that are at least partially BCG vaccinated, it is now recommended that instead of two-step testing only IGRAs be used. As the literature does not yet provide sufficient data on the accuracy of IGRAs in children younger than 5 years, the TST remains the method of choice in that age group. To date, also, no clear body of data exists to substantiate better performance for IGRAs than for the TST in older children, thus in this age group using of either test is recommended. The new recommendations also underscore the importance of a diligent preselection of close contacts in order to achieve a high probability that positive test results represent recent infection and to thus increase the benefit of chemopreventive treatment for those identified as requiring it. In a third point of update, it is noted that re-testing of contacts individuals found positive for LTBI may produce a considerable number of false-negative results and should thus be avoided in case of documented exposure.

TB or not TB? Diagnostic difficulties in HIV-positive versus HIV-negative tuberculosis patients with an immigration background in Germany

“…This result can be unsatisfactory considering that onequarter of the world's population contains TB within themselves due to contact (and even higher population parts in endemic regions). Therefore TST and IGRA should not be seen as [15][16][17][18][19][20] In particular, TST is useful applied to adult immigrants for highly endemic countries whereas IGRA is useful in children and adolescents born to immigrants from highly endemic countries that grew up in Germany or other lowrisk countries. However, it has to be taken in account that children aged younger than 5 years IGRAs may yield false negative results.…”

“…However, it has to be taken in account that children aged younger than 5 years IGRAs may yield false negative results. [16][17][18][19][20] PCR is valuable because the result is achieved promptly contrary to culture. However, it must be considered that a negative result does not rule out TB.…”

Übertragung von Tuberkulose während einer kardiopulmonalen Reanimation

“…Sie habe seit 1-2 Wochen über einen "grippalen Infekt" geklagt und deshalb seit 2-3 Tagen In Absprache mit den Ärzten des Zentrums für Infektiologie des Universitäts-klinikums, des Gesundheitsamts sowie den Betriebsärzten wurde für die Kollegen, die in diesem Einsatz involviert waren, entsprechend den Empfehlungen für die Umgebungsuntersuchung bei TBC ein Interferon γ-Test (QuantiFERON-TB® Gold-in-Tube-Test) nach 2 Monaten angeordnet [1]. Weitere Maßnah-men wurden gemäß den Empfehlungen des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose nicht empfohlen [2].…”

Tuberkulose

“…Tab . 2), kann anhand der derzeitigen Studienlage bei Erwachsenen von einer besseren Sensitivität der IGRA-Tests gegenüber dem Tuberkulinhauttest ausgegangen werden [15].…”